Ask The Doctor

Ask The Doctor

ASK THE DOCTOR

by Wesley W. Wilson, MD

NOTE: If you have any questions for "Ask the

Doctor," please send them to the VOICE editorial office. The only questions Dr.

Wilson will be able to answer are the ones used in this column.

Wesley W. Wilson, MD, has retired as
an Internal Medicine practitioner at the Western Montana Clinic in Missoula,
Montana. Dr. Wilson was diagnosed with type 1 diabetes in 1956, during his second
year of medical school. He remains interested and involved in diabetes education
for patients and professionals.

Q: I'm 42, and have just been told by my doctor

that I have diabetes. Is it curable? What can I do to get better?

A: I can understand your confusion, since there

are two types of diabetes, and many treatments. The answer to your first question is no,

neither type of diabetes can be cured, though both can be effectively treated and

controlled. Careful control of both types of diabetes is important, since with good

control of the disease, life-threatening complications can be minimized.

The confusing part is that both type 1 and type 2

diabetes share the abnormality of higher-than-normal blood sugar, but otherwise they are

clearly two different diseases. Test results suggest that the complications of both types

are caused by the high blood sugar, and that if the blood sugar is maintained near normal

(non-diabetic) levels, complications can be minimized or avoided. Such complications

include eye, kidney, and nerve abnormalities, as well as an increased risk of

cardiovascular disease.

Both types of diabetes can cause hyperglycemia,

higher than normal blood glucose levels. Elevated blood glucose has harmful effects

("glucose toxicity"), and it is necessary for persons with either type of

diabetes to measure their blood glucose and take appropriate action to keep blood glucose

levels in a safe range.

Type 1 diabetes is also known as "insulin

dependent," or "juvenile" diabetes. Persons with type 1 diabetes must

inject insulin in order to survive. This form of diabetes seems to be caused by autoimmune

destruction of the insulin-producing cells in the pancreas, resulting in an absolute lack

of insulin in persons with type 1 diabetes. Along with the necessary insulin injections, a

type 1 diabetic needs to follow proper diet, seek regular exercise, and follow a

consistent and healthy lifestyle, so as to keep the blood sugar as near normal as

possible.

Insulin acts to lower blood sugar, but it can

bring the blood sugar down too far. This is called hypoglycemia or an "insulin

reaction," and persons who take insulin injections face that risk. It is a balancing

act, avoiding sugars that are too high or too low--and a regulated sugar level can be very

hard for some type 1 diabetics to achieve.

Elevated blood sugar is also the principal

symptom of type 2 diabetes (sometimes called non-insulin-dependent diabetes). Despite the

higher-than-normal blood sugar levels, these individuals often have normal or above-normal

amounts of insulin in the blood; but, for reasons still unclear, their insulin has less

blood sugar lowering effect. This is termed insulin resistance.

Insulin resistance is not fixed, but varies with

obesity, exercise level, presence of infection, and use of steroids, such as cortisone.

Heredity also plays a role: Certain ethnic groups have a stronger tendency to develop type

2 diabetes, and the likelihood of developing it appears to be inherited.

Treatment of type 2 diabetes, like that of type

1, consists of getting the blood sugars down into the normal range. Where in type 1 this

is done with insulin injections, in type 2 diabetes it is accomplished by lessening the

insulin resistance: Proper diet, ideal weight, regular exercise, stress reduction, and

oral medications or insulin as needed.

Your doctor will discuss with you the type of

diabetes you have, and will explain what you need to do to control your blood glucose

level. Many type 2 diabetics can keep their sugar "normal" with diet and

exercise. Managing diabetes is hard work for both doctor and patient, but it is important

to do so. Keep yourself informed; both VOICE OF THE DIABETIC and the publications of the

American Diabetes Association can be helpful.